Dr suhas

DR SUHASANKLE FRACTURES

OVERVIEW

ANATOMY

NORMAL X-RAY

CLASSIFICATION

TREATMENT

ANATOMY

Mortise x-ray:• Medial clear space

o Between lateral border of medial malleous and medial talus

o <4mm is normalo >4mm suggests lateral

shift of talus

Lateral x-ray:• Identifies fractures

of o Anterior/posterior

tibial marginso Taluso Displacement of

taluso Os trigonum

Lauge-Hansen

Described by two words1.Position of foot at time of

injury2.Direction of talus within

mortise causing fracture Eg: supination-external rotation Further subdivided into

worsening areas of injury

types

supination-eversion

supination-adduction

pronation-abduction

pronation-eversion

supination-adduction

Transverse avulsion-type fracture of the

fibula below the level of the joint Vertical fracture of the medial

malleolus

10 – 20 %

Supination-Eversion (External Rotation) (SER) 40-75% Disruption of the anterior tibiofibular ligament

Spiral oblique fracture of the distal fibula, which runs from ANT INF to POST SUP

Disruption of the posterior tibiofibular

ligament or fracture of the posterior malleolus

Fracture of the medial malleolus or rupture of the deltoid ligament

Pronation-Abduction (PA)

Transverse fracture of the medial malleolus

Rupture of the syndesmotic ligaments or

avulsion fracture of their insertions Short, horizontal, oblique fracture of the

fibula above the level of the joint . Lateral communition. 5 – 20 %

Pronation-Eversion (External Rotation) (PER 5 – 20%) Transverse fracture of the medial malleolus

Disruption of the anterior tibiofibular ligament

Short oblique fracture of the fibula above the level of the joint. ANT SUP - POST INF

Rupture of posterior tibiofibular ligament or avulsion fracture of the posterolateral tibia

Danis-Weber Defines injury based on level of fibular

fracture A=below tibiotalar joint

No disruption of syndesmosis Usually stable

B=at level of tibiotalar joint Partial disruption of syndesmosis

C=above tibiotalar joint Disrupts syndesmosis to level of fracture unstable

THE MORE PROXIMAL THE FIBULAR # THE MORE SEVERE THE INJURY

Pronation-Eversion

supination-adduction

Medial Malleolus

Undisplaced

Displaced